HomeMy WebLinkAboutNCC230360_FRO Submitted_20230215Soil Erosion and Sedimentation Control
' Final ciai Responsibility/Ownership Form
-'VOT REQUZED TO BE COALDLETED FOR RESMENTUL LOT PERAHTS
PEASE READ TBE fOiLOWING %- A` ION:
I) This section must be signed in the presence of a Notary.
2) This form must be signed by the property owner if an individual. If owned by a company or corporation, this form must be signed by an officer,
director, Partner_ atwrney-m-fact, or otter person with authority to execute instruments for the corporation and accorc parried by a complete list of all
Pmanaging members and registered agents of the company or corporation_
31 This form must also be sued by the daily responsiisie party and NC agent (if applicable). Same provnasions off 2 above apply.
-) If the landowner and financially responsible party are ddM rerun, the completion and signing of this page shall serve as documentation
acknowledging the landowner consents toad authorizzs the financially responsible party to undertake the proposed land distarbing activity one the
laudownees itact(s) of laird identified on this. application-
5) The information provided on this form is true and correct to the best of my lmowledge and belief and was provided by me while'under r oath.
6) All Land-DistUrbing pit are valid for up to (2) years from the date of issuance_ If circumstances warrant, the permit may be extended for
s2) years Per the conditions of the Chatham County Soil Erosion and Sedimentation Control ordinance. Uponwrit€ens notice, the Land: Disturbing
Pelt may be revoked for failure to comply with the Ordinance. If the permit is revoked, ail otherpeamiits and approvals are withheld until
the progeny is once again in compliance with Chatham County regalattonvs. Also, upon written notice, a civil penalty (fine) cart be instigated
agamst the property owner and/or additional financially responsible party (if any) for violations of the Chatham County Soil Erosion and
SedimerniatiOn COM-ol ordinance. This penalty is up to S5000.€ 0 per violation per day and is assessed daily for every day the property is in violation.
In#eferirrg with or bampft-mg an inspection can resent in a civil penalty without written notice.
OWNER OF PROPERTY: � f
Name and Title: A L,A_p��
ikPy (if applicable):
Signature_ jj ,
FINANCIALLY RESPONSIBLE PARTY
Name and Title:
Company:
Signature: —
ORT-H CAROLINA AGENT (i any
Name and Title
Company -
Signature:
(applicable only if different from property owner):
a Notary Public of fv'j t
,g _ County- in titre state
cla hereby certify thatCt_� 4 E . it2 personally
appeamd. before me this day and under oath acknowledged readmg the information above and acknowledged that the
above farm was executed by him or her, ���ti t>I t i 11 t f jet
Witness my band and official seal, this tlic IA Wk.
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